Q. Up to what age are dependents eligible?
A. For TRICARE, unmarried dependent children are eligible up to age 21, and up to age 23 if a full-time student. For CHAMPVA, unmarried dependent children are eligible up to age 18, and up to age 23 if a full-time student.
Q. Are incapacitated dependents eligible for coverage?
A. If an incapacitated unmarried child who is covered under the policy reaches age 21 or 23, his/her coverage will not terminate due to age if he/she continues TRICARE eligibility due to the incapacity. Coverage will continue as long as the unmarried child qualifies as an incapacitated child and the required premium is paid.
Q. Are pre-existing conditions covered under the Supplement Plan?
A. Any injury or sickness whether diagnosed or undiagnosed, for which a covered person received medical care or treatment within the 6 month period preceding the effective date of his or her insurance will not be covered until the coverage has been in effect for 6 months. However, new conditions will be covered immediately.
The pre-existing condition limitation may be waived under the following conditions:
a) For individuals who are newly retired from active duty military and who enroll in the plan within 63 days of the military retirement date. Application for coverage should include a copy of their DD-214.
b) For individuals who were previously enrolled in a non-TRICARE Supplement Employer Group Plan and loses that coverage due to involuntary termination. Such individuals must enroll in the Supplement Plan within 31 days following the termination date of the prior insurance plan. Application for coverage under the Supplement Plan should include a copy of the Certificate of Creditable Coverage for the prior group insurance plan.
Q. How does the TRICARE Extra/Standard Supplement Plan coordinate with TRICARE?
A. Unless also enrolled under another Group Insurance Plan, TRICARE is the primary payer and the Supplement Plan is secondary. Thus, you are able to take full advantage of your military benefits. Your claims are filed first with TRICARE, then the TRICARE Explanation of Benefit (EOB) Statement is sent to the Supplement Plan. The Supplement Plan will pay for your TRICARE cost share, (TRICARE Standard deductible if enrolled in the Comprehensive Plan option) and covered excess charges after you meet the Supplement Plan deductible.
For CHAMPVA beneficiaries, CHAMPVA is the primary carrier. The CHAMPVA Supplement Plan pays covered cost share amounts after the plan deductible ($150 individual/ $300 family) is met.
Q. What is the difference between TRICARE Standard and TRICARE Extra?
A.TRICARE Standard and Extra are interchangeable. You can go to any authorized provider under TRICARE Standard or any network provider under TRICARE Extra. You have freedom of choice when visiting a doctor. For military retirees and eligible dependents, TRICARE pays 75% of the TRICARE Standard allowable amount or 80% of the TRICARE Extra negotiated amount, after your $150 individual/$300 family deductible has been met.
After the Supplement Plan deductible is met, the Supplement Plan pays half of your TRICARE Standard deductible (if you are enrolled in the Comprehensive Plan), plus your 20 or 25% cost share and 100% of covered excess charges up to the legal limit when providers do not accept assignment or when nonparticipating providers are used.
Q. How does the TRICARE PRIME Supplement coordinate with TRICARE Prime?
A. TRICARE Prime is a strict HMO plan, and requires a referral to see any doctor other than your primary care physician (PCM). As long as you use the military facilities under TRICARE Prime, you have no out of pocket expenses. When you use civilian doctors in the TRICARE Prime network of providers, you are responsible for copayments.
The TRICARE Prime Supplement Plan A or Plan B will reimburse covered TRICARE Prime copayment amounts.
If you see an out-of-network doctor without a referral, you are using the Point of Service (POS) option under TRICARE Prime. Under the POS option, you may have large out of pocket expenses. You first have to pay a $300 individual/$600 family deductible. After the deductible is met, TRICARE pays 50% of the allowable amount. You are responsible for the other 50%, and for any applicable charges that exceed the TRICARE Prime POS allowed amount.
The TRICARE Prime Supplement Plan B will pay the 50% cost share (if you are enrolled in the Plan B option). Please note that Plan B is not available to residents of the State of Florida.
Q. How are prescription drugs covered under the Supplement?
A. When you visit a pharmacy, show your military ID card (or CHAMPVA ID card if you are a CHAMPVA beneficiary) and pay the copayment (cost share) amount. Your prescription drug co-pay receipt (showing the name of the drug, date filled, and copayment (cost share) amount) should be submitted to Association & Society Insurance Corporation (ASI) for reimbursement.
Q. How are claims filed with the Supplement?
A. All claims are filed first with TRICARE or CHAMPVA. After TRICARE/CHAMPVA has processed your claim, they will send you an Explanation of Benefit Statement (EOB). You will need to file a claim with the Supplement Plan only if the provider has not agreed to file one on your behalf. To file a supplement claim, simply write your certificate (member ID) number on the EOB and also, write "Pay Provider" if you would like the benefits paid directly to the provider, otherwise the benefits will be paid to you.
Claims may be mailed to:
ASI, P.O. Box 2510, Rockville, MD 20847
If the provider submits claims to ASI for the Supplemental coverage, there is no need for you to submit your claim.
Q. Do most providers submit claims to TRICARE and ASI?
A. According to TRICARE, 98% of providers submit claims directly to TRICARE. Most providers will also submit claims directly to ASI for the Supplemental coverage. You should always ask your provider to file your supplemental claim for you.
Q. What happens when I reach age 65?
A. At age 65, eligibility under the TRICARE Supplement or CHAMPVA Supplement ends for members and their spouses. Coverage may be continued under the Supplement Plan if you are ineligible for Medicare or reside overseas. If ineligible for Medicare, you must submit a copy of your Social Security Disallowance Notice to ASI in order for coverage to be continued.
If at age 65, you are eligible for Medicare Part A and enrolled in Medicare Part B your TRICARE or CHAMPVA eligibility will continue. Medicare will be your primary carrier and you will have supplemental coverage under TRICARE for Life (or CHAMPVA for Life if you are a CHAMPVA beneficiary).
Q. Who is the Underwriter for the TRICARE Supplement Plan?
A. Underwritten by Hartford Life and Accident Insurance Company, Simsbury, CT 06089.
Note: These entities are not affiliated with the TRICARE Supplement in any way.
